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1.
Vet J ; 252: 105343, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31554584

RESUMO

Hyperadrenocorticism is a relatively common endocrine disorder in dogs that has been extensively described. However, its diagnosis remains challenging because there is no true reference standard test, and a myriad factors can affect the diagnostic performance of the commonly used adrenal function tests. Ultimately, the diagnosis is based on a combination of signalment, history and clinical findings, and a variety of diagnostic test results. The second part of this review aims to appraise available data on diagnostic performance of adrenal function tests in naturally occurring canine hyperadrenocorticism.


Assuntos
Testes de Função do Córtex Suprarrenal/veterinária , Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/sangue , Doenças do Cão/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Animais , Doenças do Cão/sangue , Cães
2.
Vet J ; 252: 105342, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31554593

RESUMO

Hyperadrenocorticism is a relatively common endocrine disorder in dogs. It occurs as a result of a functional pituitary or adrenal tumour, although other causes have been rarely reported. Canine hyperadrenocorticism has been extensively described but diagnosing this disease remains challenging. Few studies have investigated the clinical and clinicopathological features helpful in differentiating dogs with hyperadrenocorticism from dogs in which the disease is suspected but eventually excluded. Ultimately the diagnosis is based on a combination of multiple pieces of information emanating from the signalment, history, clinical findings, and a variety of diagnostic tests. The first part of this review aims to critically appraise the available data on epidemiology, clinical and laboratory features of naturally occurring canine hyperadrenocorticism.


Assuntos
Hiperfunção Adrenocortical/veterinária , Doenças do Cão/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Animais , Doenças do Cão/etiologia , Doenças do Cão/patologia , Doenças do Cão/fisiopatologia , Cães
3.
Khirurgiia (Mosk) ; (8): 74-78, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464279

RESUMO

ACTH-ectopic syndrome is a severe, multiple-symptom disease characterized by secretion of adrenocorticotropic hormone (ACTH) by ectopic tumor, increased release of adrenal cortical hormones and clinical picture of hypercorticism. Diagnosis and treatment of ACTH-ectopic syndrome is still difficult problem despite the achievements of modern medicine. There are several unresolved issues including optimal diagnostic algorithm, indications for various surgical procedures and their optimal dates. This review is devoted to these questions.


Assuntos
Síndrome de ACTH Ectópico/cirurgia , Hiperfunção Adrenocortical/cirurgia , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/etiologia , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/etiologia , Algoritmos , Humanos
4.
J Vet Intern Med ; 32(6): 1897-1902, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30334283

RESUMO

BACKGROUND: Current recommendation for performing the ACTH stimulation test (ACTHST) for diagnosis of hyperadrenocorticism (HAC) advocates the collection of baseline serum cortisol concentration (BC), but no references for interpretation of its results exist. OBJECTIVE: Evaluate the contribution of BC of the ACTHST to the diagnosis of HAC. ANIMALS: Fifty-four dogs were evaluated for suspected HAC at a referral hospital. METHODS: Records of dogs that had been evaluated by ACTHST for suspected HAC were reviewed. Receiver operator characteristics (ROC) analyses were used to assess the performance of BC, post-stimulation serum cortisol concentrations (PC), post-to-baseline cortisol concentration difference (DeltaC) and quotient (RatioC) for the diagnosis of HAC by comparing the area under the ROC curve (AUC) of PC to each of the other tests. RESULTS: The AUC of PC (95% confidence interval [CI]: 0.92; 95% CI, 0.81-0.98) was significantly higher than AUCs of BC (0.70; 95% CI, 0.56-0.82; P = .01) and RatioC (0.55; 95% CI, 0.41-0.69; P < .001), and was not significantly different from AUC of DeltaC (0.86; 95% CI, 0.74-0.94; P = .09). An optimal cutoff value of 683 nmol/L (24.8 µg/dL) for PC yielded a sensitivity of 86% and a specificity of 94%, respectively, and a cutoff value of 718 nmol/L (26.0 µg/dL) yielded a specificity of 100% with of 81% sensitivity for the diagnosis of pituitary-dependent HAC. CONCLUSION AND CLINICAL IMPORTANCE: The PC had good discriminatory ability for the diagnosis of HAC. It was comparable to DeltaC, whereas BC and RatioC were ineffective. Current recommendations to collect samples for BC appear redundant.


Assuntos
Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/farmacologia , Doenças do Cão/diagnóstico , Hidrocortisona/sangue , Hiperfunção Adrenocortical/sangue , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/metabolismo , Animais , Doenças do Cão/sangue , Doenças do Cão/metabolismo , Cães , Valores de Referência
5.
Medicine (Baltimore) ; 97(36): e12160, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200115

RESUMO

RATIONALE: Celiac disease (CD) is an autoimmune disorder induced by dietary gluten in genetically predisposed subjects. Activation of the hypothalamic-pituitary-axis (HPA) can occur in patients with CD; however, this condition has never been described in overweight/obese CD children. PATIENT CONCERNS: A 12-year-old girl with CD was admitted with mild acanthosis nigricans of the armpits, groin and neck. Recently, extra fat appeared around the neck, and moon face was observed. The abdomen was globular and meteoric, treatable and not aching. She weighed 64 kilos (75°-97° percentile) and was 146 centimeters tall (3°-25° percentile) with a body mass index of 30 kg/mq. Laboratory tests revealed hypertriglyceridemia and positive anti-transglutaminase IgA. Cortisoluria was determined. Serum ACTH was normal. DIAGNOSES: This paper reports a case of a girl with CD in which both obesity and activation of HPA activity were noted. INTERVENTIONS: During follow-up, anti-transglutaminase IgA increased to 201.5 UI/mL. The patient was positive for anti-endomysium antibodies, and the HLA DQ2 haplotype was identified, confirming a diagnosis of CD. OUTCOMES: Despite a gluten-free diet, obesity and hyperadrenalism persisted, and anti-transglutaminase antibodies remained elevated. In addition, high cortisoluria persisted. A high-dose suppression dexamethasone test (8 mg) produced negative results with a morning cortisol value of 1 ng/mL, suggesting the diagnosis of pseudo-Cushing's syndrome. LESSONS: This case highlights that the first manifestation of CD could be being overweight, and this finding seems to support the need to prescribe laboratory tests for CD not only to children with failure to thrive, as commonly recommended, but also to those with increased body weight.


Assuntos
Doença Celíaca/complicações , Doença Celíaca/metabolismo , Síndrome de Cushing/complicações , Síndrome de Cushing/metabolismo , Hiperfunção Adrenocortical/complicações , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/metabolismo , Hiperfunção Adrenocortical/terapia , Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Criança , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Diagnóstico Diferencial , Feminino , Humanos , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/metabolismo , Obesidade/terapia
6.
Can Vet J ; 59(8): 905-907, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30104785

RESUMO

An 11-year-old spayed female shih tzu dog was presented with pollakiuria, stranguria, and hematuria. Radiographs revealed a large number of radiodense urinary calculi within the bladder. Physical examination, complete blood cell count, biochemistry and ACTH stimulation test suggested possible hyperadrenocorticism. A cystotomy was performed and the patient was treated for hyperadrenocorticism.


Assuntos
Hiperfunção Adrenocortical/veterinária , Doenças do Cão/diagnóstico , Cálculos Urinários/veterinária , Hiperfunção Adrenocortical/diagnóstico , Animais , Cistotomia/veterinária , Di-Hidrotestosterona/análogos & derivados , Di-Hidrotestosterona/uso terapêutico , Doenças do Cão/cirurgia , Cães , Inibidores Enzimáticos/uso terapêutico , Feminino , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
7.
J Vet Intern Med ; 32(3): 967-977, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29498108

RESUMO

BACKGROUND: Dogs with hyperadrenocorticism (HAC) may be more mildly affected at the time of diagnosis today, which could influence the prevalence of associated clinical and clinicopathological abnormalities and diagnostic test performance. Different low-dose dexamethasone suppression test (LDDST) result patterns have not been evaluated individually. OBJECTIVES: To assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ. ANIMALS: One hundred and twenty-three dogs undergoing investigation for HAC. METHODS: Retrospective evaluation of dogs in which a LDDST was performed and HAC confirmed or excluded by alternative means. Cases with basal cortisol concentrations (t0 ) < 1 µg/dL were excluded. Each LDDST result was classified as (a) complete suppression (t3 and t8 < 1 µg/dL), (b) lack of suppression (t3 and t8 > 1 µg/dL and both > 50% t0 ), (c) partial suppression (t3 and t8 > 1 µg/dL but either < 50% t0 ), (d) escape (t8 > 1 µg/dL and t3 < 1 µg/dL) or (e) inverse (t3 > 1 µg/dL and t8 < 1 µg/dL) pattern. RESULTS: Fifty-nine (48%) dogs were diagnosed with HAC and 64 (52%) with non-adrenal illness. Hyperadrenocorticism cases had similar clinicopathological abnormalities compared to previous reports. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (95% confidence interval [CI]) of the LDDST for diagnosing HAC were 96.6 (91.9-100)%, 67.2 (55.7-78.7)%, 73.1 (63.2-82.9)%, and 95.6 (89.5-100)%, respectively. Lack of suppression pattern had the highest PPV (93.9 [85.8-100]%) followed by the partial suppression pattern (67.9 [50.6-85.2]%) and escape or inverse pattern (36.8 [15.1-58.5]%). CONCLUSIONS AND CLINICAL IMPORTANCE: A lack of suppression LDDST pattern has the highest PPV for diagnosing HAC followed by a partial suppression pattern. By contrast, the escape or inverse pattern provided limited support of HAC.


Assuntos
Hiperfunção Adrenocortical/veterinária , Dexametasona/farmacologia , Hiperfunção Adrenocortical/diagnóstico , Hormônio Adrenocorticotrópico/farmacologia , Animais , Doenças do Cão , Cães , Feminino , Hidrocortisona/sangue , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Adv Exp Med Biol ; 1039: 67-82, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28795359

RESUMO

Disturbances of the steroidogenesis or altered peripheral metabolism of steroids may result in severe clinical manifestations. Therefore, prompt diagnosis and initiation of medical treatment are desirable. The diagnostics of disorders of steroid hormone production, metabolism, and action have been previously based on immunoassay tests. However, in a modern medical laboratory, due to low accuracy of immunoassays, this technique is continuously replaced by chromatographic separation methods coupled to mass spectrometric detection systems. In this review we present current advances in the diagnostics of adrenal gland disorders, focusing on the role of mass spectrometry in prenatal and newborn screening, and in the diagnostics of sexual maturation disorders.


Assuntos
Doenças do Sistema Endócrino/diagnóstico , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Humanos , Recém-Nascido , Espectrometria de Massas , Triagem Neonatal , Diagnóstico Pré-Natal
9.
Rev. chil. endocrinol. diabetes ; 10(4): 150-153, oct. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-999026

RESUMO

A case study of a 41 years old woman with cyclic hypercortisolism is explained. AT the beginning, its manegment was shrinking the tumor, however afterward she needs medical treatment during cycles. The fluctuating clinical and discrepant bioquemical findings make it hard to diagnose. A review of this rare disorder is explained.


Assuntos
Humanos , Adulto , Neoplasias Hipofisárias/complicações , Adenoma/complicações , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiologia , Neoplasias Hipofisárias/diagnóstico , Fatores de Tempo , Adenoma/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/etiologia
10.
J Feline Med Surg ; 19(9): 933-947, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28838299

RESUMO

Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).


Assuntos
Hiperfunção Adrenocortical/veterinária , Doenças do Gato/diagnóstico , Doenças do Gato/terapia , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/terapia , Animais , Gatos
11.
J Vet Intern Med ; 31(3): 730-733, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28407319

RESUMO

BACKGROUND: Standard protocols for adrenocorticotropic hormone (ACTH) stimulation testing (ACTHst) often involve intravenous (IV) injection of corticotropin. ACTH might be unintentionally injected into the perivascular (PV) space. OBJECTIVE: To compare stimulation test results after IV and PV injections of ACTH. ANIMALS: Twenty privately owned dogs were studied: 10 healthy and 10 with trilostane-treated naturally occurring hyperadrenocorticism (HAC). METHODS: Prospective study. Each of 20 dogs underwent 2 ACTHst not <4 nor more than 14 days apart. Five healthy and 5 HAC dogs had an IV ACTHst first and PV second; 5 healthy and 5 HAC dogs had a PV ACTHst first and IV second. Blood samples for measurement of serum cortisol concentration were collected before and 1 hour after ACTH administration. RESULTS: No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in all 20 dogs (median µg/dL; interval µg/dL: 8.2; 1.4-17.4 versus 7.8; 0.9-16.9; P = .23). No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in the 10 healthy dogs (median µg/dL; interval µg/dL: 10.9; 7.3-17.4 versus 10.6; 7.1-16.9; P = .54) or in the 10 HAC dogs (median µg/dL; interval µg/dL: 6.3; 1.4-8.6 versus 5.2; 0.9-8.7; P = .061). CONCLUSIONS AND CLINICAL IMPORTANCE: Perivascular administration of ACTH does not significantly alter stimulation test results in healthy dogs or in dogs with HAC undergoing therapy with trilostane.


Assuntos
Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/administração & dosagem , Doenças do Cão/diagnóstico , Hidrocortisona/sangue , Hiperfunção Adrenocortical/diagnóstico , Animais , Estudos de Casos e Controles , Doenças do Cão/sangue , Cães , Feminino , Injeções Intravenosas/veterinária , Injeções Subcutâneas/veterinária , Masculino
12.
Horm Metab Res ; 48(10): 677-681, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27643448

RESUMO

Cortisol diurnal variation may be abnormal among patients with endogenous Cushing syndrome (CS). The study objective was to compare the plasma cortisol AM/PM ratios between different etiologies of CS. This is a retrospective cohort study, conducted at a clinical research center. Adult patients with CS that underwent adrenalectomy or trans-sphenoidal surgery (n=105) were divided to those with a pathologically confirmed diagnosis of Cushing disease (n=21) and those with primary adrenal CS, including unilateral adrenal adenoma (n=28), adrenocortical hyperplasia (n=45), and primary pigmented nodular adrenocortical disease (PPNAD, n=11). Diurnal plasma cortisol measurements were obtained at 11:30 PM and midnight and at 7:30 and 8:00 AM. The ratios between the mean morning levels and mean late-night levels were calculated. Mean plasma cortisol AM/PM ratio was lower among CD patients compared to those with primary adrenal CS (1.4±0.6 vs. 2.3±1.5, p<0.001, respectively). An AM/PM cortisol ratio≥2.0 among patients with unsuppressed ACTH (>15 pg/ml) excludes CD with a 85.0% specificity and a negative predictive value (NPV) of 90.9%. Among patients with primary adrenal CS, an AM/PM cortisol≥1.2 had specificity and NPV of 100% for ruling out a diagnosis of PPNAD. Plasma cortisol AM/PM ratios are lower among patients with CD compared with primary adrenal CS, and may aid in the differential diagnosis of endogenous hypercortisolemia.


Assuntos
Doenças do Córtex Suprarrenal/diagnóstico , Adenoma Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Ritmo Circadiano/fisiologia , Síndrome de Cushing/sangue , Hidrocortisona/sangue , Doenças do Córtex Suprarrenal/sangue , Doenças do Córtex Suprarrenal/etiologia , Adrenalectomia , Adenoma Adrenocortical/sangue , Adenoma Adrenocortical/etiologia , Hiperfunção Adrenocortical/sangue , Hiperfunção Adrenocortical/etiologia , Adulto , Síndrome de Cushing/complicações , Síndrome de Cushing/fisiopatologia , Síndrome de Cushing/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
13.
J Vet Intern Med ; 30(5): 1637-1641, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27425787

RESUMO

BACKGROUND: Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical. OBJECTIVES: To compare the cortisol response to 1 and 5 µg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC. ANIMALS: Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15). PROCEDURES: In this prospective study, healthy dogs had consecutive ACTH stimulation tests to ensure 2 tests could be performed in sequence. For the first test, cosyntropin (1 µg/kg IV) was administered; the second test was initiated 4 hours after the start of the first (5 µg/kg cosyntropin IV). Dogs suspected of having HAC or being treated with mitotane were tested as the healthy dogs. Dogs receiving trilostane treatment were tested on consecutive days at the same time post pill using the low dose on day 1. RESULTS: In dogs being treated with mitotane or trilostane, the 2 doses were pharmacodynamically equivalent (90% confidence interval, 85.1-108.2%; P = 0.014). However, in dogs suspected of having HAC, the doses were not pharmacodynamically equivalent (90% confidence interval, 73.2-92.8%; P = 0.37); furthermore, in 23% of the dogs, clinical interpretation of test results was different between the doses. CONCLUSIONS AND CLINICAL RELEVANCE: For dogs suspected of having HAC, 5 µg/kg cosyntropin IV is still recommended for ACTH stimulation testing. For dogs receiving mitotane or trilostane treatment, a dose of 1 µg/kg cosyntropin IV can be used.


Assuntos
Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/metabolismo , Cosintropina/farmacologia , Doenças do Cão/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/tratamento farmacológico , Animais , Antineoplásicos/uso terapêutico , Estudos de Casos e Controles , Cosintropina/administração & dosagem , Di-Hidrotestosterona/análogos & derivados , Di-Hidrotestosterona/uso terapêutico , Cães , Relação Dose-Resposta a Droga , Feminino , Hormônios/administração & dosagem , Hidrocortisona/sangue , Masculino , Mitotano/uso terapêutico
14.
J Clin Endocrinol Metab ; 101(7): 2768-75, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27144939

RESUMO

CONTEXT: Subtle hypercortisolism is associated with an increased risk of vertebral fracture (VFx). OBJECTIVE: The objective was to determine the best parameters of cortisol secretion for detecting the VFx risk in patients with adrenal incidentalomas (AI). DESIGN: This was a retrospective (cross-sectional arm) and prospective (longitudinal arm) design. In the cross-sectional arm, we assessed the accuracy of the cortisol secretion indexes in identifying the patients with VFx (prevalent VFx). In the longitudinal arm, we tested the cortisol secretion parameters, which were able to identify the prevalent VFx, for the prediction of the occurrence of a new VFx (incident VFx) in AI patients followed-up for at least 2 years. SETTING: Four referral Italian endocrinology units participated in this study. PATIENTS: A total of 444 and 126 AI patients without symptoms of hypercortisolism enrolled in the cross-sectional arm and longitudinal arm, respectively. MAIN OUTCOME MEASURES: Serum cortisol after a 1-mg dexamethasone suppression test (1 mg DST), urinary free cortisol, ACTH, bone mineral density at lumbar spine and femoral neck (by dual-energy x-ray absorptiometry), and the VFx presence (by x-ray). RESULTS: The cortisol levels after 1 mg DST that were greater than 2.0 µg/dl (55 nmol/liter) were the best criteria for detecting patients with both prevalent (73.6% sensitivity, 70.5% specificity) and incident VFx (80% sensitivity, 68.8% specificity) and were associated with a 10-fold increased risk of a new VFx (odds ratio,10.27; 95% confidence interval, 3.39-31.12; P < .0001), regardless of age, gender, bone mineral density at lumbar spine, and prevalent VFx. CONCLUSIONS: In AI patients without symptoms of overt hypercortisolism, the cortisol levels after 1 mg DST greater than 2.0 µg/dl (55 nmol/liter) represent the best criterion for detecting prevalent and incident VFx.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Hiperfunção Adrenocortical/complicações , Hidrocortisona/sangue , Fraturas da Coluna Vertebral/diagnóstico , Absorciometria de Fóton , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/metabolismo , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Estudos Transversais , Feminino , Colo do Fêmur , Humanos , Hidrocortisona/metabolismo , Estudos Longitudinais , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fraturas da Coluna Vertebral/sangue , Fraturas da Coluna Vertebral/etiologia , Adulto Jovem
16.
Pediatr Int ; 56(6): 813-816, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24862636

RESUMO

BACKGROUND: Hyperadrenergic postural tachycardia syndrome (POTS) is the main phenotype of POTS. The aim of this study was to present our single-center experience of hyperadrenergic POTS in children and adolescents. METHODS: Thirty-seven patients who met the diagnostic criteria for POTS were enrolled in our study. Their orthostatic serum norepinephrine levels were determined by high-performance liquid chromatography. In a retrospective analysis, based on clinical and serum norepinephrine criteria, we analyzed the clinical features of POTS cases between the POTS-alone group and the hyperadrenergic POTS group. RESULTS: Nineteen patients (51.35%) met the diagnostic criteria for hyperadrenergic POTS and 18 patients were assigned to the POTS-alone group. Compared with the POTS-alone patients, dizziness, headache and tremulousness were more frequent in patients with hyperadrenergic POTS (P < 0.05). During the tilt table test, children with hyperadrenergic POTS had a greater increment of systolic blood pressure and heart rate than POTS-alone patients. CONCLUSION: Patients with hyperadrenergic POTS should be identified and differentiated from those with neuropathic POTS. Hyperadrenergic POTS in children and adolescents should be considered when POTS patients suffer from frequent dizziness, headache, and tremulousness. In head-up tilt testing, children and adolescents with hemodynamic characteristics of hyperadrenergic POTS had greater increments of systolic blood pressure and heart rate.


Assuntos
Hiperfunção Adrenocortical/complicações , Hiperfunção Adrenocortical/diagnóstico , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Adolescente , Hiperfunção Adrenocortical/fisiopatologia , Criança , Feminino , Humanos , Masculino , Norepinefrina/sangue , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Estudos Retrospectivos
17.
J Vet Intern Med ; 28(4): 1239-43, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24863172

RESUMO

BACKGROUND: Trilostane medical treatment of naturally occurring hyperadrenocorticism (NOH) in dogs is common, as is use of the adrenocorticotropic hormone (ACTH) stimulation test (ACTHst) in monitoring response to treatment. There is uncertainty regarding when the ACTHst should be started relative to time of trilostane administration. OBJECTIVE: To compare ACTHst results in dogs being treated for NOH with trilostane when the test is begun 2 versus 4 hours after trilostane administration. ANIMALS: Twenty-one privately owned dogs with NOH, each treated with trilostane for at least 30 days. METHODS: Each dog had 2 ACTHst completed, 1 started 2 hours and the other 4 hours after trilostane administration. The second test was started no sooner than 46 hours and no later than 74 hours after the first. RESULTS: For all 21 dogs, the mean post-ACTH serum cortisol concentration from tests started 2 hours after trilostane administration (5.4 ± 3.7 µg/dL) was significantly lower (P = .03) as compared with results from the tests started 4 hours after administration (6.5 ± 4.5 µg/dL). CONCLUSIONS: Results of ACTHst started at different times yield significantly different results. Dogs with NOH, treated with trilostane, and monitored with ACTHst results should have all of their subsequent ACTHst tests begun at or about the same time after trilostane administration.


Assuntos
Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/sangue , Di-Hidrotestosterona/análogos & derivados , Doenças do Cão/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/tratamento farmacológico , Hiperfunção Adrenocortical/fisiopatologia , Hormônio Adrenocorticotrópico/agonistas , Animais , Di-Hidrotestosterona/uso terapêutico , Doenças do Cão/diagnóstico , Doenças do Cão/fisiopatologia , Cães , Feminino , Hidrocortisona/sangue , Masculino , Fatores de Tempo
18.
J Vet Intern Med ; 28(2): 473-80, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24495125

RESUMO

BACKGROUND: Treatment of adrenal-dependent hyperadrenocorticism (ADH) involves either surgical resection of the adrenal tumor or medical therapy. For many years, mitotane has been considered the medical treatment of choice for dogs with ADH. OBJECTIVES: The aim of this study was to determine survival and prognostic factors for dogs with ADH treated with mitotane and trilostane. ANIMALS: Twenty-six dogs with ADH were included in the study. METHODS: Fourteen dogs were treated with mitotane and 12 dogs were treated with trilostane. Medical records were reviewed. Epidemiologic factors, signalment, clinicopathologic abnormalities, endocrine test results, and treatment protocols were evaluated to identify potential predictive factors of overall survival time. RESULTS: Survival times of dogs treated with mitotane (median, 15.6 months) or trilostane (median, 14.0 months) were not significantly different. Using univariate analysis, age and postadrenocorticotropic hormone cortisol concentrations were inversely correlated with survival time. The multivariate model also identified weakness at presentation as a negative prognostic indicator. CONCLUSION AND CLINICAL IMPORTANCE: The type of medical treatment (mitotane versus trilostane) does not influence survival time in dogs with ADH; therefore, trilostane, a drug with less frequent and milder adverse effects, might be used as the primary medical treatment when adrenalectomy cannot be performed.


Assuntos
Hiperfunção Adrenocortical/veterinária , Di-Hidrotestosterona/análogos & derivados , Doenças do Cão/tratamento farmacológico , Mitotano/uso terapêutico , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/tratamento farmacológico , Hiperfunção Adrenocortical/mortalidade , Animais , Di-Hidrotestosterona/administração & dosagem , Di-Hidrotestosterona/uso terapêutico , Doenças do Cão/diagnóstico , Doenças do Cão/mortalidade , Cães , Feminino , Estimativa de Kaplan-Meier , Masculino , Mitotano/administração & dosagem , Prognóstico , Análise de Sobrevida
19.
J Vet Intern Med ; 28(2): 481-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24433386

RESUMO

BACKGROUND: Spontaneous hyperadrenocorticism (HAC) is rare in cats. Clinical findings, diagnostic test results, and response to various treatment options must be better characterized. OBJECTIVES: To report the clinical presentation, clinicopathologic findings, diagnostic imaging results, and response to treatment of cats with HAC. ANIMALS: Cats with spontaneous HAC. METHODS: Retrospective descriptive case series. RESULTS: Thirty cats (15 neutered males, 15 spayed females; age, 4.0-17.6 years [median, 13.0 years]) were identified from 10 veterinary referral institutions. The most common reason for referral was unregulated diabetes mellitus; dermatologic abnormalities were the most frequent physical examination finding. Low-dose dexamethasone suppression test results were consistent with HAC in 27 of 28 cats (96%), whereas ACTH stimulation testing was suggestive of HAC in only 9 of 16 cats (56%). Ultrasonographic appearance of the adrenal glands was consistent with the final clinical diagnosis of PDH or ADH in 28 of 30 cats (93%). Of the 17 cats available for follow-up at least 1 month beyond initial diagnosis of HAC, improved quality of life was reported most commonly in cats with PDH treated with trilostane. CONCLUSIONS AND CLINICAL IMPORTANCE: Dermatologic abnormalities or unregulated diabetes mellitus are the most likely reasons for initial referral of cats with HAC. The dexamethasone suppression test is recommended over ACTH stimulation for initial screening of cats with suspected HAC. Diagnostic imaging of the adrenal glands may allow rapid and accurate differentiation of PDH from ADH in cats with confirmed disease, but additional prospective studies are needed.


Assuntos
Hiperfunção Adrenocortical/veterinária , Doenças do Gato/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/tratamento farmacológico , Hiperfunção Adrenocortical/patologia , Hiperfunção Adrenocortical/fisiopatologia , Animais , Doenças do Gato/tratamento farmacológico , Doenças do Gato/patologia , Doenças do Gato/fisiopatologia , Gatos , Di-Hidrotestosterona/análogos & derivados , Di-Hidrotestosterona/uso terapêutico , Feminino , Masculino , Estudos Retrospectivos , Resultado do Tratamento
20.
J Vet Intern Med ; 27(6): 1292-304, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24112317

RESUMO

This report offers a consensus opinion on the diagnosis of spontaneous canine hyperadrenocorticism. The possibility that a patient has hyperadrenocorticism is based on the history and physical examination. Endocrine tests should be performed only when clinical signs consistent with HAC are present. None of the biochemical screening or differentiating tests for hyperadrenocorticism are perfect. Imaging can also play a role. Awareness of hyperadrenocorticism has heightened over time. Thus, case presentation is more subtle. Due to the changes in manifestations as well as test technology the Panel believes that references ranges should be reestablished. The role of cortisol precursors and sex hormones in causing a syndrome of occult hyperadrenocorticism remains unclear.


Assuntos
Hiperfunção Adrenocortical/veterinária , Consenso , Doenças do Cão/fisiopatologia , Hidrocortisona/metabolismo , Hiperfunção Adrenocortical/diagnóstico , Hiperfunção Adrenocortical/fisiopatologia , Animais , Doenças do Cão/diagnóstico , Cães , Feminino , Hidrocortisona/sangue , Masculino
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